Abstract
Purpose
Thromboses occur in connection with the use of venous port systems. Valid data on the instillation of heparin-based solutions in the lumen of the port system are lacking.
Methods
One hundred and seventy-three patients with malignancy from 19 centres who had participated in an observation study of subcutaneous thromboprophylaxis with dalteparin-Na (Fragmin P/-Forte) were analysed with a view to flushing the port systems and investigating any related influence on the occurrence of catheter-associated thromboses.
Results
All catheter-associated thromboses were seen in centres which used either no UFH, or UFH concentrations of up to 250 IU/ml (8/108; 7.4%). The rate of thrombosis rose to 10% (6/60) if no high-risk dose of dalteparin was applied subcutaneously. On the other hand, the rate of catheter-associated thromboses under the high-risk dose of dalteparin and/or a more highly concentrated instillation fluid, at 0.9% (1/113), was much lower. One haemorrhage from gastric ulcer occurred under the highest UFH concentration in the instillation fluid (2,500 IU UFH/ml).
Conclusion
The results indicate that a concentration between 500 IU UFH/ml and 1,000 IU UFH/ml in the instillation solution, at the same time as high-risk prophylaxis with subcutaneous dalteparin for prevention of catheter-associated thromboses, is effective in patients with manifest tumour disease. The instillation of LMWH-based solutions at a concentration of approx 500 anti-Xa units/ml should be discussed as a pending issue.
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References
Bolufer-Cano JM, Grau-Cardonna E, Almela-Cortina J, Aguilo-Lucia J, Martinez-Mas E, Serrano-Durba A, Martin-Delgado J, Delgado-Gomis F (1995) Venous reservoirs: the late complications according to route of implantation. The Interhospital Group of Valencia (GIHV). Nutr Hosp 10:340–347
De Cicco M, Matovic M, Balestreri L, Panarello G, Fantin D, Morassut S, Testa V (1997) Central venous thrombosis: an early and frequent complication in cancer patients bearing long term silastic catheter. A prospective study. Thromb Res 86: 101 – 113
Delva R, Gamelin E, Lortholary A, Maillart P, Leynia de la Jarrige P, Girault C, Guérin J, Larra F (1998) Suppression of heparinization of central venous catheters between cycles of chemotherapy. Support Care Cancer 6:384–388
Eastridge BJ, Lefor AT (1995) Complications of indwelling venous access devices in cancer patients. J Clin Oncol 13:233–238
Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA, Wheeler HB (2001) Prevention of venous thromboembolism. Chest 119:132S-175S
Karaaslan H, Peyronnet P, Benevent D, Lagarde C, Rince M, Leroux-Robert C (2001) Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis. Nephrol Dial Transplant 16:2072–2074
Lagro SWJ, Verdonck LF, Borel Rinkes IHM, Dekker AW (2000) No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients. Bone Marrow Transplantation 26:1103–1106
Lersch C, Eckel F, Sader R, Paschalidis M, Zeilhofer F, Schulte-Frohlinde E, Theiss W (1999a) Initial experience with Healthport miniMax and other peripheral arm ports in patients with advanced gastrointestinal malignancy. Oncology 57:269 – 275
Lersch C, Paschalidis M, Theiss W (1999b) Tiefe Venenthrombosen durch zentralvenöse Katheter. VASA 28:71–78
Lersch C, Kotowa W, Janssen D (2002) Thromboembolieprophylaxe mit Dalteparin-Na (Fragmin) bei onkologischen Patienten nach Port-Implantationen. TumorDiagn u Ther 23:104–110
Levine MN (1997) Prevention of thrombotic disorders in cancer patients undergoing chemotherapy. Thromb Haemost 78:133 – 136
Mayo DJ, Cullinane AM, Merryman PK, McDonald KH (1999) Serologic evidence of heparin sensitization in cancer patients receiving heparin flushes of venous access devices. Support Care Cancer 7:425–427
Monreal M, Raventos A, Lerma R, Ruiz J, Lafoz E, Alastrue A, Llamazares JF (1994) Pulmonary embolism in patient with upper extremity DVT associated to venous central lines – A prospective study. Thromb Haemost 72:548–550
Monreal M, Alastrue A, Rull M, Mira X, Muxart J, Rosell R, Abad A (1996) Upper extremity deep venous thrombosis in cancer patients with venous access devices – prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost 75:251 – 253
Perez-Requejo JL, Lucena-Solano O, Perez-Garcia M, Santarelli MT (1997) Very low doses of unfractionated heparin potentiate the anti-Xa activity of low molecular weight heparin (enoxaparin). Thromb Res 85:259–265
Randolph AG, Cook DJ, Gonzales CA, Andrew M (1998) Benefit of Heparin in central venous and pulmonary artery catheters. A meta-analysis of randomized controlled trials. Chest 113:165–171
Reichardt P (2002) Katheterassoziierte Thrombosen. Oral presentation at Pharmacia Satellite-Symposium during DGHO-Congress, Munich. 10 October 2002
Solomon B, Moore J, Arthur C, Prince HM (2001) Lack of efficacy of twice-weekly urokinase in the prevention of complications associated with Hickman catheters: a multicentre randomised comparison of urokinase versus heparin. Eur J Cancer 37:2379–2384
Stas KJF, Vanwalleghem J, de Moor B, Keuleers H (2001) Trisodium citrate 30% vs heparin 5% as catheter lock in the interdialytic period in twin- or double-lumen dialysis catheters for intermittent hemodialysis. Nephrol Dial Transplant 16:1521
Wandel E, Klingel R, Köhler H (1992) Antikoagulation bei chronischer Dialyse. Arzneimitteltherapie 10:310–313
Warkentin TE, Chong BH, Greinacher A (1998) Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost 79:1-7
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This work was financially supported by Pharmacia, Am Wolfsmantel 46, 91058 Erlangen, Germany
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Lersch, C., Kotowa, W., Fung, S. et al. Prophylaxis of port system-associated thromboses in advanced oncology patients using heparin flushing. J Cancer Res Clin Oncol 130, 235–241 (2004). https://doi.org/10.1007/s00432-003-0528-5
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DOI: https://doi.org/10.1007/s00432-003-0528-5